Programa de Reestruturação e Contratualização dos Hospitais Filantrópicos no SUS: uma avaliação dos eixos de assistência, gestão e financiamento

Abstract

This paper aims at analysing the National Hospital Care Policy and focuses on the Restructuring and Contracting Non-profit Hospitals Programme within the Brazilian Unified Health System (SUS). The Ministry of Health adopted that strategy in 2005 in order to change contract rules between non-profit healthcare providers and local administrations. The traditional funding model (pay-per-procedure according to a SUS fees framework) was replaced by mixed contracts in which payments are made as quantity and quality targets are met. The programme aims at mitigating financial problems non-profit hospitals face, and at improving healthcare and management quality. Through case studies of two contracted healthcare providers, this research gathered and analysed quantitative and qualitative data that allowed us to identify the impacts, achievements, gaps and problems of the programme. The main findings of the assessment are: non-compliance with programme rules by the Contract Monitoring Committee, making it harder to achieve the expected results; improvement in hospital care and management ever since foundations adhered to the programme, although it is not possible to affirm that one is a direct consequence of the other; the new contract model is more satisfactory in terms of finance, but it still does not solve the problems; and lack of communication, transparency, controlling and social participation in the process.